graph TD
A[<b>LD dx between Jan 2013 - Oct 2024 <br> 2,466,251 eyes, 1,551,502 patients </b>]
A --> B[<b>Exclusions</b>: <br> - <u>Missing laterality</u>: <br> 111,753 eyes, 53,074 patients<br> - <u>Loss to F/U</u>: 979,067 eyes, 623,785 patients<br> -<u> Missing demographic data</u>: 523,430 eyes, 331,437 patients]
B --> C[<b>Remaining</b>: 852,001 eyes, 543,206 patients]
C --> D[<b>Observation group</b>: 719,173 eyes, 479,454 patients]
C --> E[<b>Prophylaxis group</b>: 132,828 eyes, 109,930 patients]
D --> F[<b>LD</b>: 689,428 eyes, 465,133 patients]
D --> G[<b>LD+ hole</b>: 29,745 eyes, 25,190 patients]
E --> H[<b>LD</b>: 112,097 eyes, 94,740 patients]
E --> I[<b>LD+ hole</b>: 20,731 eyes, 18,416 patients]
Outcomes in lattice degeneration
BPEI Biostatistics Center
Project details
Hypothesis:
Patients with lattice degeneration alone who undergo prophylactic intervention will not have improved outcomes compared to those who are observed. However, those with lattice degeneration with holes may benefit from prophylactic treatment.
Rationale:
Lattice degeneration is seen in 30% of patients with retinal detachment. However, a natural history study of lattice degeneration by Byer in 1989 concluded that lattice degeneration progresses to retinal detachment in only 1.08% of eyes. Byer’s study concluded that prophylaxis for lattice degeneration was not indicated in a majority of cases. However, the study was limited by small sample size (n=276 patients, 423 eyes) and poor follow-up rates. The purpose of this study is to explore the natural course and clinical outcomes of prophylaxis for lattice degeneration in a larger, more contemporary, dataset (IRIS).
Data extraction
Summary of data
Tables
Variable | N = 543,2061 |
|---|---|
Sex | |
Female | 312,716 (58%) |
Male | 230,490 (42%) |
Race | |
Asian | 26,648 (4.9%) |
Black Or African American | 46,424 (8.5%) |
Other | 63,247 (12%) |
White | 406,887 (75%) |
Ethnicity | |
Hispanic Or Latino | 36,518 (6.7%) |
Not Hispanic Or Latino | 506,688 (93%) |
urban_rural | |
Rural | 45,341 (8.3%) |
Unknown | 1,238 (0.2%) |
Urban | 496,627 (91%) |
Region | |
Midwest | 102,917 (19%) |
Northeast | 115,382 (21%) |
South | 179,495 (33%) |
U.S. territories | 1,847 (0.3%) |
Unknown | 78,382 (14%) |
West | 65,183 (12%) |
Follow up (months) | 54.50 (56.63) |
1n (%); Median (IQR) | |
| Observation, N = 719173 | Prophylaxis, N = 132828 | ||||
|---|---|---|---|---|---|---|
Characteristic | N | No RD | Yes RD | N | No RD | Yes RD |
Age at LD diagnosis | 719,173 | 59.00 (46.00, 68.00) | 57.00 (49.00, 64.00) | 132,828 | 57.00 (46.00, 64.00) | 56.00 (49.00, 62.00) |
Right eye | 719,173 | 337,871 (49%) | 15,431 (52%) | 132,828 | 62,062 (49%) | 2,878 (50%) |
Lens status | 719,173 | 132,828 | ||||
Aphakia | 1,931 (0.3%) | 109 (0.4%) | 169 (0.1%) | 24 (0.4%) | ||
Phakic | 596,616 (87%) | 24,235 (81%) | 114,674 (90%) | 4,795 (84%) | ||
Pseudophakia | 90,789 (13%) | 5,493 (18%) | 12,254 (9.6%) | 912 (16%) | ||
LD + hole | 719,173 | 28,504 (4.1%) | 1,241 (4.2%) | 132,828 | 20,255 (16%) | 476 (8.3%) |
Interval from LD dx to prophylaxis | 0 | NA (NA, NA) | NA (NA, NA) | 132,828 | 28.00 (0.00, 441.00) | 17.00 (0.00, 284.00) |
Complication post RD | 719,173 | 0 (0%) | 4,878 (16%) | 132,828 | 0 (0%) | 4,018 (70%) |
Follow up (months) | 719,173 | 55.02 (29.10, 86.07) | 56.17 (30.47, 85.60) | 132,828 | 58.40 (31.27, 89.40) | 68.23 (40.67, 96.70) |
1Median (Q1, Q3); n (%) | ||||||
Characteristic | No RD | Yes RD | p-value2 |
|---|---|---|---|
Sex | <0.001 | ||
Female | 413,595 (60%) | 12,303 (41%) | |
Male | 275,741 (40%) | 17,534 (59%) | |
Race | <0.001 | ||
Asian | 35,533 (5.2%) | 1,017 (3.4%) | |
Black Or African American | 63,366 (9.2%) | 1,588 (5.3%) | |
Other | 79,313 (12%) | 3,647 (12%) | |
White | 511,124 (74%) | 23,585 (79%) | |
Ethnicity | <0.001 | ||
Hispanic Or Latino | 45,730 (6.6%) | 1,746 (5.9%) | |
Not Hispanic Or Latino | 643,606 (93%) | 28,091 (94%) | |
Region | <0.001 | ||
Midwest | 128,070 (19%) | 6,724 (23%) | |
Northeast | 153,542 (22%) | 4,708 (16%) | |
South | 228,802 (33%) | 9,114 (31%) | |
U.S. territories | 2,060 (0.3%) | 42 (0.1%) | |
Unknown | 96,129 (14%) | 5,711 (19%) | |
West | 80,733 (12%) | 3,538 (12%) | |
Age at LD diagnosis | 59.00 (46.00, 68.00) | 57.00 (49.00, 64.00) | <0.001 |
LD + hole | 28,504 (4.1%) | 1,241 (4.2%) | 0.837 |
Right eye | 337,871 (49%) | 15,431 (52%) | <0.001 |
Lens status | <0.001 | ||
Aphakia | 1,931 (0.3%) | 109 (0.4%) | |
Phakic | 596,616 (87%) | 24,235 (81%) | |
Pseudophakia | 90,789 (13%) | 5,493 (18%) | |
Interval from LD dx to prophylaxis | NA (NA, NA) | NA (NA, NA) | |
Complication | >0.999 | ||
Epiretinal Membrane | 0 (NA%) | 0 (0%) | |
Metamorphopsia | 0 (NA%) | 0 (0%) | |
Pneumatic Retinopexy | 0 (NA%) | 195 (4.0%) | |
Postoperative Vitreous Hemorrhage | 0 (NA%) | 0 (0%) | |
PPV +/- SB | 0 (NA%) | 1,835 (38%) | |
Repair of complex RD | 0 (NA%) | 2,737 (56%) | |
Scleral buckle | 0 (NA%) | 111 (2.3%) | |
Follow up (months) | 55.02 (29.10, 86.07) | 56.17 (30.47, 85.60) | <0.001 |
1n (%); Median (Q1, Q3) | |||
2Pearson's Chi-squared test; Wilcoxon rank sum test; Fisher's exact test | |||
Characteristic | No RD | Yes RD | p-value2 |
|---|---|---|---|
Sex | <0.001 | ||
Female | 68,451 (54%) | 2,012 (35%) | |
Male | 58,646 (46%) | 3,719 (65%) | |
Race | <0.001 | ||
Asian | 6,251 (4.9%) | 164 (2.9%) | |
Black Or African American | 10,608 (8.3%) | 256 (4.5%) | |
Other | 16,096 (13%) | 659 (11%) | |
White | 94,142 (74%) | 4,652 (81%) | |
Ethnicity | <0.001 | ||
Hispanic Or Latino | 9,837 (7.7%) | 330 (5.8%) | |
Not Hispanic Or Latino | 117,260 (92%) | 5,401 (94%) | |
Region | <0.001 | ||
Midwest | 24,714 (19%) | 1,229 (21%) | |
Northeast | 23,481 (18%) | 820 (14%) | |
South | 41,803 (33%) | 1,977 (34%) | |
U.S. territories | 842 (0.7%) | 10 (0.2%) | |
Unknown | 20,048 (16%) | 868 (15%) | |
West | 16,209 (13%) | 827 (14%) | |
LD + hole | 20,255 (16%) | 476 (8.3%) | <0.001 |
Age at LD diagnosis | 57.00 (46.00, 64.00) | 56.00 (49.00, 62.00) | <0.001 |
Right eye | 62,062 (49%) | 2,878 (50%) | 0.040 |
Lens status | <0.001 | ||
Aphakia | 169 (0.1%) | 24 (0.4%) | |
Phakic | 114,674 (90%) | 4,795 (84%) | |
Pseudophakia | 12,254 (9.6%) | 912 (16%) | |
Interval from LD dx to prophylaxis | 28.00 (0.00, 441.00) | 17.00 (0.00, 284.00) | <0.001 |
Complication | >0.999 | ||
Epiretinal Membrane | 0 (NA%) | 2,071 (52%) | |
Metamorphopsia | 0 (NA%) | 4 (<0.1%) | |
Pneumatic Retinopexy | 0 (NA%) | 26 (0.6%) | |
Postoperative Vitreous Hemorrhage | 0 (NA%) | 1,408 (35%) | |
PPV +/- SB | 0 (NA%) | 214 (5.3%) | |
Repair of complex RD | 0 (NA%) | 287 (7.1%) | |
Scleral buckle | 0 (NA%) | 8 (0.2%) | |
Follow up (months) | 58.40 (31.27, 89.40) | 68.23 (40.67, 96.70) | <0.001 |
1n (%); Median (Q1, Q3) | |||
2Pearson's Chi-squared test; Wilcoxon rank sum test; Fisher's exact test | |||
1. What is the percentage of patients with lattice degeneration (all variations) with and without prophylaxis (defined by CPT 67145) that progress to retinal detachment (RD) needing repair (as defined by CPT: 67110, 67107, 67108, 67113?)
| group_type | total | rd_cases | rd_percentage |
|---|---|---|---|
| Observation | 719173 | 29837 | 4.148793 |
| Prophylaxis | 132828 | 5731 | 4.314602 |
| group_type | hole | total | rd_cases | rd_percentage |
|---|---|---|---|---|
| Observation | No | 689428 | 28596 | 4.147786 |
| Observation | Yes | 29745 | 1241 | 4.172130 |
| Prophylaxis | No | 112097 | 5255 | 4.687904 |
| Prophylaxis | Yes | 20731 | 476 | 2.296078 |
Percentage of Patients that progress to RD
2. Of those that received prophylactic treatment (for LD and LD + H) what was the rate of retinal detachment requiring repair over time (T1, 3MO PP, 6MO PP, 1 year PP, 2 years PP, etc. up to as many years available in repository. PP = post-prophylaxis)?
3. Is there a difference in visual outcomes between the observation and prophylaxis groups?
The plot shows the comparison of visual acuity at different time points across the two group types.
Comparison of VA for both groups
4. Is there a difference in visual outcomes post retinal detachment repair between observation and prophylaxis groups?
Comparison of VA post RD
All data
‘Unknown’ shows where missing demographic data
Variable | N = 873,8681 |
|---|---|
Sex | |
Female | 496,203 (57%) |
Male | 364,395 (42%) |
Unknown | 13,270 (1.5%) |
Race | |
Asian | 34,261 (3.9%) |
Black Or African American | 58,528 (6.7%) |
Other | 88,037 (10%) |
Unknown | 183,145 (21%) |
White | 509,897 (58%) |
Ethnicity | |
Hispanic Or Latino | 51,620 (5.9%) |
Not Hispanic Or Latino | 543,505 (62%) |
Unknown | 278,743 (32%) |
urban_rural | |
Rural | 70,013 (8.0%) |
Unknown | 3,095 (0.4%) |
Urban | 800,760 (92%) |
Region | |
Midwest | 152,401 (17%) |
Northeast | 192,771 (22%) |
South | 265,517 (30%) |
U.S. territories | 5,684 (0.7%) |
Unknown | 123,781 (14%) |
West | 133,714 (15%) |
Follow up (months) | 48.67 (53.67) |
1n (%); Median (IQR) | |
The echo: false option disables the printing of code (only output is displayed).